Provider Demographics
NPI:1013356161
Name:TYGER RIVER PEDIATRIC DENTISTRY
Entity Type:Organization
Organization Name:TYGER RIVER PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LENORA
Authorized Official - Middle Name:G
Authorized Official - Last Name:COVINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:864-266-5030
Mailing Address - Street 1:312 SPARTANBURG HWY.
Mailing Address - Street 2:
Mailing Address - City:LYMAN
Mailing Address - State:SC
Mailing Address - Zip Code:29365
Mailing Address - Country:US
Mailing Address - Phone:864-439-4449
Mailing Address - Fax:864-439-5559
Practice Address - Street 1:312 SPARTANBURG HWY.
Practice Address - Street 2:
Practice Address - City:LYMAN
Practice Address - State:SC
Practice Address - Zip Code:29365
Practice Address - Country:US
Practice Address - Phone:864-439-4449
Practice Address - Fax:864-439-5559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-21
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC38961223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty